Diagnostic

• Laboratory studies are used for two purposes:

1. to confirm the diagnosis 2. to determine the extent of organ

involvement and severity of complications.

Patient Laboratory Worksheet

• Blood Chemistry-Na, K, BUN, Creatinine, Alkaline phosphatase, iPO4, iCa, SGOT, SGPT

• CBC (complete blood count)• MAT• Ultrasound (whole abdomen)• Chest X-ray• Anti-HAV IgM, HBsAg, AntiHBs, AntiHBc IgG

Laboratory Findings In Leptospirosis

• ESR – Increased• Leukocyte Count – ranges from 3,000-26,000/microliter• Mild Thrombocytopenia• Elevated levels of Bilirubin & ALP• Mild increase in serum levels of aminotransferases• PT may be prolonged• Elevated Creatine Phosphokinase

• Harrison’s, Internal Medicine, 17th Ed.

Radiologic Findings

• Patchy alveolar pattern, corresponds to scattered alveolar hemorrhage, affect lower lobes in the periphery of the lung fields.

• Harrison’s, Internal Medicine, 17th Ed.

BLOOD CHEMISTRY 09/16 09/18 09/19 09/21 Normal Values

BUN 41.6 29.4 21.3 7–20 mg/dL

Creatinine 3.3 1.8 1.6 1.3 0.6–1.2 ng/mL

Alkaline phosphatase 166 33–96 U/L

Total bilirubin 5.3 0.3–1.3 mg/dL

Direct bilirubin 4.2 0.1–0.4 mg/dL

Indirect bilirubin 1.1 0.2–0.9 mg/dL

Na 130 134 142 136–146 meq/L

K 3.7 3.3 4.7 3.5–5.0 meq/L

iPO4 2.8 2.5–4.3 mg/dL

iCa 1.06 4.5–5.3 mg/dL

URINALYSIS 09/16/09 09/17/09 Normal Values

Color Yellow Yellow

Transparency Slightly turbid Slightly turbid

pH 5.0 5.0 5.0–9.0

Specific Gravity 1.010 1.015 1.001–1.035

Albumin - -

Sugar - -

RBCs 5-7/hpf 0-1/hpf 0–2/high powerfield

Pus cells 3-6/hpf 3-6/hpf 0–2/high powerfield

Squamous cells Few Few None

Bacteria + + None

Amorphous urate + +

CBC 09/16/09 Normal Values

Hgb 118 133–162 g/L

RBC 5.63 4.30–5.60 x 1012/L

Hct 0.35 0.388–0.464

MCV 61.60 79–93.3 fL

MCH 20.40 26.7–31.9 pg/cell

MCHC 33.40 32.3–35.9 g/dL

RDW 15.20 < 14.5%

MPV 7.0 9.00–12.95 fL

Plt 234 165–415 x 109/L

WBC 11.40 5-10 x 109/L

Neutro 0.89

Bands 0.02 0.0-0.05

Seg 0.87 0.40–0.70

Lympho 0.10 0.20–0.50

Eosino 0.01 0.0–0.6

09/18

Prothrombin time 12.7

Normal control 12.5

PT ratio 1.0

INR 1.0

aPTT 45.6

Normal control 36.3

CHEMILUMINESCENT IMMUNOASSAY

09/16

Anti HAV IgM 0.254nonreactive

• Ultrasound of the LGBPS (09/15/09): Normal sized liver with fatty changes, slightly contracted gallbladder, ultrasonologically normal pancreas, spleen, kidneys and urinary bladder, prostatic hypertrophy with concretions

• MAT (done last 09/18/09 in UP-PGH): Positive (indicative of Leptospirosis)

• Chest Xray (09/18/09): Subsegmental atelectasis, left lobe

• ECG (09/18/09): Sinus rhythm, left axis deviation, nonspecific ST-T wave changes

Microscopic Agglutination Test (MAT)

• Principle: Antibodies in the test serum react with antigens on the surface of the bacteria and agglutinate them.

• A single MAT titer of or 1:400 on any sera or identification of spirochetes on dark-field microscopy, when accompanied by the appropriate clinical scenario, is strongly suggestive.

o A positive MAT was defined as a single titer of >1:400 or a 4-fold rise in titer between acute and convalescent sera samples, confirms the diagnosis of leptospirosis.

» CDC (Centers for Disease Control)